Funded Projects

Problem:

North Dakota is a vastly rural and frontier state with a relatively small population, covering approximately 69,000 square miles with a 2022-estimated population of 779,261 people. North Dakota residents live in a mixture of several densely populated cities (metropolitan), many smaller towns (micropolitan), and large geographic areas of low population density (rural). All five federally recognized tribes encompass predominantly rural areas of the state. North Dakota currently ranks 48th in the nation for population density with 11.3 people per square mile. The distribution of North Dakota's population density creates challenges in the delivery of efficient health and behavioral health services. As of June 2022, 48.7% of North Dakota residents live in rural areas. The PMHCA grant will continue to serve the entire state with a focus on rural and underserved communities.

Goals and Objectives:

The North Dakota PMHCA Program will work towards equitable access by focusing on the following primary goals:

• Increase the capacity of primary care providers to screen, diagnose and treat children for behavioral health disorders in primary care settings.
• Develop and create capacity for telehealth programs in community-based settings by expanding partnerships within Emergency Departments and schools.

To accomplish the first goal to Increase the capacity of primary care providers to screen, diagnose and treat children for behavioral health disorders in primary care settings, the following, summarized objectives were identified: 1) Increase the number of children receiving access to Telebehavioral health care in primary care settings by 25% by 2026 and 2) for North Dakota's PMHCA efforts to work towards achieving health equity related to racial, ethnic and geographical disparities in access to behavioral health services.

To accomplish the second goal to develop and create capacity for telehealth programs in community-based settings by expanding partnerships within Emergency Departments and schools, the following, summarized objectives were identified: 1) Strengthen and expand training and implementation of integrated behavioral health support in schools to increase the number of students receiving tele-behavioral health services and 2) Build capacity within the Emergency Departments and provide training and technical assistance to identify risk factors and early warning signs.

Methodology:

The ND PMCHA will provide consultation, training, TA and care coordination support to pediatric primary care providers and other providers through implementation of activities supporting the following two primary goals:

1. Increase the capacity of primary care providers to be able to screen, diagnose and treat children for behavioral health disorders in primary care settings;
2. Develop and create capacity for telehealth programs in community-based settings by expanding partnerships within Emergency Departments and schools. 

Trainings will be provided to a targeted group of providers and will take place via an online platform and include but are not limited to the following topics: Adverse Childhood Experiences (ACEs) assessment training, Screening, Brief Intervention, and Referral to Treatment (SBIRT), specific screening tools, and virtual training that addresses child, youth, and family engagement, and diagnosis of mental health and substance use disorders.

Consultation is also a key piece of the PMHCA program. The consultation model will allow for the primary care settings and other established partners to utilize the previously established care consultation line with Family Voices. A representative from Family Voices receives the initial call from the primary care setting and obtains key information for the consult. Information is then relayed to the appropriate psychiatrist, psychologist, mental health counselor or licensed addiction counselor. When the appropriate provider completes the consultation, a secured email is sent back to Family Voices of North Dakota outlining any additional services that should be considered. Family Voices of North Dakota also contacts the family if a release of information is obtained to determine if there are any other resources that can be acquired for the family. These resources may include gas assistance, transportation, food, heating assistance, etc. Our goal is to expand provider enrollment, particularly to a diverse workforce to better serve diverse communities in this consultation process.

In addition to consultation within primary care settings, it is the goal of North Dakota's PMHCA program to expand consultation into the school systems. The process of expansion will include partnerships with ND Full-Service Community Schools (NDFSCS), the Youth Advisory Council, New American communities, and Tribal Liaisons. By increasing access points for care, peer support, and care coordination, more youth and families will have access to behavioral health services, especially in rural and underserved areas through telehealth treatment services. We are confident that by increasing partnerships and access points, we will be able to achieve the following:

• Increase the number of children receiving follow-up care services following ED visits
• Increase the service equity and enrollments among American Indian and other ethnic groups within the state through fostering relationships with the Tribal Health Liaisons

Direct behavioral/mental health care has not been part of the PMHCA model to date. The PMHCA team will assess the need for direct health care needs to be made available in primary care settings through assessments with appropriate stakeholders.

Coordination:

The North Dakota Department of Health and Human Services' Behavioral Health Division

(BHD) will continue to contract with partner organizations to manage the care consultation line and provide real time care coordination for families engaged in the PMHCA Program. The 2018-2023 PMHCA Program implementation partnered with Family Voices of North Dakota to answer the care consultation line and coordinate with providers and families. BHD will seek to contract with a family-based agency to facilitate and expand care coordination efforts by following ND procurement guidelines.

Evaluation:

The ND PMHCA Program data management and evaluation plan is aligned with program goals. The data plan will evolve based on what we learn from providers, care coordination partners, and the direct experiences of youth and families receiving PMHCA services. The data and evaluation plan will be updated annually and integrated into the ND PMHCA Sustainability Plan.